title: Various techniques of stent-assisted coil embolization of wide-necked or fusiform artherosclerotic and dissecting unruptured vertebrobasilar artery aneurysms for reducing recanalization: mid-term results.
abstract: BACKGROUND
  Coil embolization of wide-necked or fusiform vertebrobasilar aneurysms is challenging and tends to involve frequent recanalization.
  
  
  OBJECTIVE
  The aim of our study was to evaluate complications and mid-term outcomes of complex vertebrobasilar artery aneurysms after stent-assisted coiling with various techniques.
  
  
  METHODS
  We retrospectively evaluated 28 cases of unruptured vertebrobasilar aneurysm treated by stent-assisted coiling.
  
  
  RESULTS
  Forty-four of the 45 stents placed in 28 patients were deployed at the desired location (97.8 %). Single stent-assisted coiling was performed in 14 aneurysms, a stent-within-a-stent (SWS) technique was used in 12 aneurysms, and Y-stent-assisted coiling was employed in four basilar tip aneurysms. Two basilar tip aneurysms treated by single stent-assisted coiling recurred and were retreated by SWS and Y-stent-assisted coiling. Complete embolization was achieved in 19 aneurysms (67.8 %), and remnant neck persisted in eight aneurysms (28.6 %) and remnant aneurysm was noted in one aneurysm (3.6 %). Permanent neurologic deficit (Modified Rankin Scale 1 and 4) was noted in two patients (7.1 %). Angiographic follow-up (mean follow-up period: 20.8 months) was performed in 20 patients. Major recanalization occurred in two basilar tip aneurysms (10 %) and minor compaction was noted in one superior cerebellar artery aneurysm. The remaining 17 aneurysms were stable or improved (85 %).
  
  
  CONCLUSIONS
  Complex vertebrobasilar aneurysm embolization with stent-assisted techniques was effective and feasible as a method for reducing recanalization during midterm angiographic follow-up. Large and wide-necked basilar tip aneurysms showed frequent major recanalization, and compact packing with single or Y-stent-assisted coiling is needed to prevent recanalization even if coiling will be done without stenting.
authors.affiliation: Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong Jongro-ku, Seoul, South Korea, 110-746, Republic of Korea, rmh96@dreamwiz.com.
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Rho
authors.forename: Hee Jin
authors.initials: HJ
authors.lastname: Park
authors.forename: Eun Chul
authors.initials: EC
authors.lastname: Chung
authors.forename: Yoon Jung
authors.initials: YJ
authors.lastname: Choi
authors.forename: So Yeon
authors.initials: SY
authors.lastname: Lee
authors.forename: Yu Sam
authors.initials: YS
authors.lastname: Won
authors.forename: Byung Moon
authors.initials: BM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000628:therapy*; D001488:Basilar Artery / Q000601:surgery*; D002533:Cerebral Angiography / Q000379:methods; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy*; D008875:Middle Aged; D012189:Retrospective Studies; D055502:Secondary Prevention; D015607:Stents; D016896:Treatment Outcome